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Abstract
Background
Type 2 diabetes mellitus is a common, chronic and costly disease. Its prevalence is rapidly increasing worldwide. Diabetes has big economic burden mainly because of its chronic complications. We analyzed the annual direct medical costs of type 2 diabetic patients, including the costs associated with its complications in Korea retrospectively.
Methods
We enrolled 531 type 2 diabetic patients who had been treated in the 3 Tertiary Hospital in 2005. Clinical characteristics, duration of diabetes, modality of glycemic control, and presence of microvascular and macrovascular complications were assessed by the review of medical records. The annual direct medical costs were assessed using the hospital electronic database and included insurance covered and uncovered medical costs.
Results
The annual direct medical costs of type 2 diabetic patients without any complications was 1,184,563 won (95% CI for mean: 973,006~1,396,121 won). Compared to diabetic patients without complications, annual total medical costs increased 4.7-fold, 10.7-fold, and 8.8-fold in patients with microvascular complications, macrovascular complications and both complications, respectively. Hospitalization costs largely increased by 78.7-fold and 61.0-fold in patients with macrovascular complications and both complications, respectively. Major complications to increase medical costs were kidney transplantation (23.1-fold), dialysis (21.0-fold), PTCA or CABG (12.4-fold), and leg amputation (11.8-fold). The total medical costs dramatically increased according to the stage of diabetic retinopathy and nephropathy.
Figures and Tables
Fig. 1
Annual medical costs per patient according to the diabetic complication groups. The total medical costs increased 4.7-fold, 10.7-fold and 8.8-fold in patients with microvascular complications, macrovascular complications and both complications compared to diabetic patients without complications, respectively. Both, both microvascular and macrovascular complications; Macro only, macrovascular complications only; Micro only, microvascular complications only; Office visit, total office visit costs except medication costs.
Fig. 2
Proportion of sub-costs on total medical costs per patient according to the diabetic complication groups. Hospitalization costs largely increased and accounted for 65~70% of the total medical costs in patients with macrovascular complications. Micro-complication only, microvascular complications only; Macro-complication only, macrovascular complications only; Both complications, both microvascular and macrovascular complications; Micro only, microvascular complications only; Office visit, total office visit costs except medication costs.
Fig. 3
Annual total medical costs per patient according to the stage of diabetic retinopathy. The total medical costs increased 3.0-fold and 6.1-fold in patients with NPDR and PDR who had been treated with operation compared to diabetic patients without complications. NPDR, non-proliferative diabetic retinopathy; PDR, proliferative diabetic retinopathy.
Fig. 4
Annual total medical costs per patient according to the stage of diabetic nephropathy. The total medical costs dramatically increased according to the stage of diabetic nephropathy.
Fig. 5
Annual total medical costs per patient according to the diabetic macrovascular complications. The total medical costs increased 12.4-fold and 11.8-fold in patients with PTCA or CABG and leg amputation compared to diabetic patients without complications. CABG, coronary artery bypass graft; CAOD, coronary artery occlusive disease; CVA, cerebrovascular accident; PTCA, percutaneous transluminal coronary angioplasty.
Table 3
Annual direct medical costs according to the diabetic complication groups (Unit: won)
Both, both microvascular and macrovascular complications; CI, confidence interval; Macro only, macrovascular complications only; Micro only, microvascular complications only; Office visit, total office visit costs except medication costs; SD, standard deviation. *P value, compared with no complication group by independent samples t-test.
Table 4
Annual direct medical costs per patient according to the diabetic complications (Unit: Won)
CABG, coronary artery bypass graft; CAOD, coronary artery occlusive disease; CVA, cerebrovascular accident; DM, diabetes mellitus; NPDR, non-proliferative diabetic retinopathy; Office visit, total office visit costs except medication costs; PDR, proliferative diabetic retinopathy; PTCA, percutaneous transluminal coronary angioplasty.
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